Fibromyalgia (FM) & migraine, 2 faces of the same mechanism. Serotonin as the common clue for pathogenesis & therapy

In this study fibromyalgia sufferers were randomly administered a
combination of monoamine-oxidase inhibitors (MAOIs)-A/B with
5-HTP, 5-HTP alone, MAOIs-A/B alone, or the tricyclic drug
amitriptyline in order to compare the efficacy of these
treatments. The benefits on the painful syndrome were assessed
by using Visual Analogic Scale score rating from 0 to 4. The
combination of MAOIs with 5-HTP significantly improved
fibromyalgia syndrome as determined by Visual Analogic Scale
whereas the other treatments yielded poorer benefits. No
subject withdrew from the trial due to adverse effects, even
if some sleep disturbances and mild stomach-ache were
reported. The tolerability of the association MAOIs/5-HTP was
good, although a transient cheese effect occurred in one of
the patients treated with MAOIs as well as in a patient
treated with the association MAOIs and 5-HTP. No one of these
two cases was due to pharmacological dietetic mistake of the
patient. In both the cases the transient hypertension was
associated to very dramatic emotional events. The benefits
obtained by using the combination of MAOIs with 5-HTP can be
explained with a treatment-induced enhancement of aminergic
and serotonergic transmission. The recently shown high
prevalence of migraine in the population of fibromyalgia
sufferers, suggests a common ground shared by fibromyalgia
and migraine. Migraine has been demonstrated to be
characterized by a defect in the serotonergic and adrenergic
systems. A parallel dramatic failure of serotonergic systems
and a defect of adrenergic transmission have been evidenced
to affect fibromyalgia sufferers too. Enhancing serotonergic
analgesia while increasing adrenergically mediated analgesia
seems to be an important tool in fibromyalgia. Treatment
consisting with the association MAOIs/5-HTP is aimed at
enhancing serotonergic/adrenergic transmission by inducing an
up-regulation of serotonergic/adrenergic receptors and a
simultaneous increase of serotonin levels in the central
nervous system.

Nicolodi M, Sicuteri F

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